Cost-Effectiveness of Zonisamide Versus Levetiracetam in Newly Diagnosed Focal Onset Epilepsy in Serbia

Abstract

Objectives: When choosing initial therapy for epilepsy, the decision should be supported by studies that include both treatment outcome and costs. This is especially important for developing countries with restricted budgets because such circumstances are also characterized by higher epilepsy prevalence rates. The aim of this study was to compare cost-utility of zonisamide (ZNS) and levetiracetam (LEV) in patients with newly diagnosed focal-onset epilepsy in the Republic of Serbia. Methods: A 5-state, 3-month-cycle Markov model was created to compare ZNS and LEV. The model assumed that patients whose seizures were not controlled by treatment with either ZNS or LEV would be continued on carbamazepine in controlled-release form in the second cycle and would then be treated with a pregabalin add-on if still not adequately controlled. The perspective of the Serbian Republic Health Insurance Fund was chosen, and the time horizon was 15 years. Model results were obtained after Monte Carlo microsimulation of a sample with 1000 virtual patients. Both multiple one-way and probabilistic sensitivity analyses were performed. Results: After base-case analysis, LEV was dominated by ZNS because the net monetary benefit was positive (16 940.78 ± 22 572.26 Serbian dinars; €144.09 ± €191.99) and the incremental cost-effectiveness ratio was below the willingness-to-pay threshold of 3 Serbian gross domestic products per capita per quality-adjusted life-year gained. Multiple one-way and probabilistic sensitivity analyses confirmed the results of the base-case simulation. Conclusions: ZNS has a more beneficial cost-effectiveness ratio than LEV for the treatment of newly diagnosed focal epilepsy in Serbian milieu.